| NPI | 1003566589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 112931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 6274) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-08-12 |